Recent epidemiological evidence suggests that effects of cardiovascular risk factors may vary depending on sex and age. In this study, we assessed the associations of metabolic syndrome (MetS) with sarcopenia and its components in older adults, and examined whether the associations vary by sex and age. We also tested if any one of the MetS components could explain the associations. We conducted a cross-sectional analysis of the baseline data from the cohort study conducted in Kashiwa city, Chiba, Japan in 2012 which included 1971 functionally-independent, community-dwelling Japanese adults aged 65 years or older (977 men, 994 women). Sarcopenia was defined based on appendicular skeletal muscle mass, grip strength and usual gait speed. MetS was defined based on the National Cholesterol Education Program's Adult Treatment Panel-III criteria. The prevalence of sarcopenia was 14.2% in men and 22.1% in women, while the prevalence of MetS was 43.6% in men and 28.9% in women. After adjustment for potential confounders, MetS was positively associated with sarcopenia in men aged 65 to 74 years (odds ratio 5.5; 95% confidence interval 1.9-15.9) but not in older men or women. Among the sarcopenia components, MetS was associated with lower muscle mass and grip strength, particularly in men aged 65 to 74 years. The associations of MetS with sarcopenia and its components were mainly driven by abdominal obesity regardless of sex or age. In conclusion, MetS is positively associated with sarcopenia in older men. The association is modified by sex and age, but abdominal obesity is the main contributor to the association across sex and age.

Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimers disease (AD). DLB is characterised by intracytoplasmic inclusions called Lewy bodies that are often seen in the brainstem. Because modulation of the respiratory rhythm is one of the most important functions of the brainstem, patients with DLB may exhibit dysrhythmic breathing. This hypothesis has not yet been systematically studied. Therefore, we evaluated the association between DLB and dysrhythmic breathing.

Gnetum gnemon is an arboreal dioecious plant that is cultivated in Indonesia. The seeds of this species mainly contain dimeric stilbenoid compounds [gnetin C (1), gnemonoside A (2), and gnemonoside D (3)] along with trans-resveratrol (4). trans-Resveratrol has been reported to have antiaging, anticancer, and antidiabetic effects, as well as being a calorie restriction mimetic. SIRT1 exerts a protective effect against vascular senescence. In this study, the effects of these four main stilbenoid derivatives of a G. gnemon seed endosperm ethanolic extract on endothelial senescence were investigated. In streptozotocin-induced diabetic mice, administration of the G. gnemon ethanolic extract increased SIRT1 and decreased endothelial senescence. The concentration of 1 in blood plasma was 6-fold higher than 4 in these mice. Next, the in vitro effects of the four main stilbenoid derivatives of G. gnemon seeds were investigated. Senescent human umbilical vein endothelial cells were induced by hydrogen peroxide. Endothelial senescence was inhibited by 4, which increased the expression of endothelial nitric oxide synthase and SIRT1, whereas 1-3 had no effect. These results indicated that the ethanolic extract of G. gnemon seeds inhibits endothelial senescence, suggesting that 4 plays a critical role in the prevention of endothelial senescence.

Acute exogenous lipoid pneumonia is an uncommon condition caused by aspiration of oil-based substances, occurring mainly in children. Here, we report the case of an 83-year-old patient with Alzheimers disease who presented with coughing and hypoxia. The diagnosis of acute exogenous lipoid pneumonia caused by accidental kerosene ingestion was made on the basis of the patients clinical history, and typical radiological and cytological findings. The patients cognitive impairment and an unsafe environment, in which the patients 91-year-old husband stored kerosene in an old shochu bottle, were responsible for the accidental ingestion. Acute exogenous lipoid pneumonia should be considered in the differential diagnosis for acute respiratory disorders in the rapidly aging population.

Vascular aging manifest several features, namely atherosis, sclerosis and calcified change. Vascular calcification makes the management of hemodynamics more difficult in the elderly, because ectopic calcium deposition in the vasculatures contributes to excessive blood pressure variability, isolated systolic hypertension with increased arterial wave reflectance, and subsequent ischemic cardiovascular (CV) events. Vascular calcification has been shown to result from passive precipitation of calcium with aging and osteoporosis. However, accumulating recent evidences have shown it to be attributable to an activecell-mediated processresembling osteogenesis in bone rather than passive mineral precipitation in vascular smooth muscle cells (SMC) . Cellular senescence has been recently shown to be linked to atherosclerogenesis ; however, few reports have addressed whether cellular senescence is associated with SMC calcification. Our new findings show that the senescent phenotypic change is associated with osteoblastic trans-differentiation in SMC and mammalian sirtuin SIRT1, which is well known as a longevity gene, can play an inhibitory role in the cellular senescence-related vascular calcification under hyperphosphatemia. In addition, the activation of Runx2, a potent osteogenic transcriptional factor, in SMC is regulated by SIRT1-p21 axis. The identification of therapeutic targets which can slow down the progression or even reverse the senescent phenotypic change in SMC could be an important step forward in the treatment of vascular calcification.

On 11 March 2011, a strong earthquake occurred off of Japans Pacific coast and hit northeastern Japan. The earthquake was followed by huge tsunamis, which destroyed many coastal cities. As a result, the Study Group on Guidelines for the First Steps and Emergency Triage to Manage Elderly Evacuees quickly established guidelines enabling non-medical care providers (e.g. volunteer, helpers, and family members taking care of elderly relatives), public health nurses, or certified social workers to rapidly detect illnesses in elderly evacuees, and 20?000 booklets were distributed to care providers in Iwate, Miyagi, and Fukushima prefectures. The aim of this publication is to reduce susceptibility to disaster-related illnesses (i.e. infectious diseases, exacerbation of underlying illnesses, and mental stress) and deaths in elderly evacuees.

Vascular calcification causes management of hemodynamics more difficult and finally leads to cardiovascular events in the clinical setting. Thinking about the crucial mechanisms of vascular calcification, recent researches reveal the evidence of a biological linkage between bone and vascular calcification. Accumulating evidences show that vascular calcification is attributable to an active cell-mediated process resembling osteogenesis in bone rather than passive mineral precipitation, so called calcium shift theory, as a previous hypothesis. Especially, major mechanism shows the importance of phenotypic transformation of vascular smooth muscle cells into osteo/chondrocytic-like cells under correlation of bone morphogenetic proteins, potent osteo/chondrogenic transcription factors Runx2, and so on. The detailed understanding of the complex mechanisms may lead to new opportunity to find the therapeutic strategies, concordantly enhancing bone mineral density and preventing vascular calcification.

Arterial calcification is associated with cardiovascular disease as a complication of advanced atherosclerosis. Aged vascular cells manifest some morphological features of a senescent phenotype. Recent studies have demonstrated that mammalian sirtuin 1 (SIRT1), a histone deacetylase, is an exciting target for cardiovascular disease management. Here, we investigated the role of SIRT1 in a calcification model of vascular smooth muscle cells (SMCs).

Widespread vascular calcification is a ubiquitous feature of aging and is prevalent in association with several atherosclerotic diseases. HMG-CoA reductase inhibitors (statins) have been shown to exert protective potentials against cardiovascular diseases via the lipid-lowering and/or their independent pleiotropic effects. Recently, statins have been extensively investigated as potential therapeutic agents capable of slowing the progression of vascular and valvular calcification. However, accumulating recent evidences show that there are conflicting data regarding beneficial effects of statins on progression of cardiovascular calcification. In particular, regarding coronary artery calcification, which is shown to can predict coronary events, it still remains unclear and controversial. To address the positioning of statins as therapeutic strategy for cardiovascular calcification more clearly, clinical studies by intensive therapy using statins throughout long-term period is indispensable in near future. In addition, future investigation about the detailed molecular mechanisms how statins affect calcification process in vascular cells is necessary.

Atherosclerotic vascular damage associated with aging manifest several features, namely atherosis, sclerosis and calcified change, finally leading to cardiovascular (CV) events. Accumulating recent reports show the importance of cellular senescence in atherosclerogenesis; however, few reports have addressed whether cellular senescence is associated with smooth muscle cells (SMC) calcification. Recent report has demonstrated the association of senescent phenotypic change with osteoblastic trans-differentiation in VSMC. In addition, our new findings show that the possibility of dynamic action of sirtuin, which is well known as a longevity gene, as a negative regulator in the cellular senescence-related vascular calcification. Strategies how to manage senescent phenotypic change in VSMC may provide novel therapeutic opportunities for the prevention of vascular calcification.

Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) have pleiotropic vascular protective effects besides cholesterol lowering. Recently, experimental and clinical studies have indicated that senescence of endothelial cells is involved in endothelial dysfunction and atherogenesis. Therefore, the present study was performed to determine whether statins would reduce endothelial senescence and to clarify the molecular mechanisms underlying the antisenescent property of statins.

We report the findings regarding a 70-year-old man with paraneoplastic limbic encephalitis. He presented with a chief complaint of inability to recall any events. He had been well until one month before admission, and then he abruptly began to show progressive amnesia. At admission, the patients score on the Revised Hasegawa Dementia Scale (HDS-R) showed a decline to 13/30, thus indicating the existence of severe disorientation and an impaired memory. The brain CT and EEG showed no specific abnormalities and an analysis of cerebrospinal fluid showed only a mild increase in the total protein level. A chest X-ray film revealed a mass in the right hilum, while a histological analysis of the biopsied specimen finally established a diagnosis of small cell lung carcinoma. The FDG-PET and the enhanced brain MRI showed a single small metastatic lesion in the cerebellum. After the 1st course of chemotherapy and whole brain radiation, cognitive function, especially the short-term memory, remarkably improved and the HDS-R score increased to 21/30. However, the tumor again increased in size during the 3(rd) and 4(th) courses of chemotherapy. Interestingly, cognitive function also worsened again and the score of HDS-R declined to 15/30, 20 weeks after the start of chemotherapy. Limbic encephalitis can be associated with malignant tumors, such as small cell lung carcinoma, and some reported cases have shown a cognitive improvement after tumor therapy. In our case, we also observed a reworsening of the cognitive function in association with the acquired chemoresistence.

Epidemiological studies have shown that low testosterone is associated with metabolic syndrome (MetS) in Caucasian men. We investigated whether testosterone level is related to the prevalence of MetS in middle-aged Japanese men. A cross-sectional survey was conducted in 194 men aged 30-64 years (49+/-9). Blood sampling was performed in the morning after a 12-h fast, and the relationship between plasma hormone and MetS was analyzed. Low total testosterone was associated with MetS according to the Japanese criteria (HRs of 2.02 by quartile of testosterone; 95% CI=1.43-2.87) and the International Diabetes Federation criteria (HRs of 1.68 by quartile of testosterone; 95% CI=1.25-2.25). Age-adjusted regression analyses revealed that testosterone was significantly related to the MetS parameters of obesity (beta=-0.365 and -0.343 for waist circumference and body mass index, respectively), hypertension (beta=-0.278 and -0.157 for systolic and diastolic blood pressure, respectively), dyslipidemia (beta=-0.242 and 0.228 for triglycerides and high-density lipoprotein cholesterol, respectively), insulin resistance (beta=-0.253 and -0.333 for fasting plasma glucose and homeostasis model assessment of insulin resistance, respectively) and adiponectin (beta=0.216). Inclusion of waist circumference into the model largely weakened the association of testosterone with other metabolic risk factors. In contrast, high estradiol was associated with MetS and its parameters, mostly attributing to the positive correlation between estradiol and obesity. Dehydroepiandrosterone sulfate was not associated with MetS or its parameters. These results suggest that low testosterone is associated with MetS and its parameters in middle-aged Japanese men. The association between estradiol and MetS needs further investigation.

Sir2 (silent information regulator-2), an NAD(+)-dependent histone deacetylase, is highly conserved in organisms ranging from archaea to humans. Yeast Sir2 is responsible for silencing at repeated DNA sequences in mating-type loci, telomeres and rDNA, and plays critical roles in DNA repair, stress resistance and longevity.The phenomenon of human aging is known to be a critical cardiovascular risk factor. Senescence of endothelial cells has been proposed to be involved in vascular dysfunction and atherogenesis. Recent studies have demonstrated that mammalian Sirt1 NAD(+)-dependent protein deacetylase, the closest homologue of Sir2, regulates vascular angiogenesis, homeostasis and senescence. This review focuses on SIRT1 as a potential therapeutic target against atherosclerosis.

Recent epidemiological studies have found that androgen deficiency is associated with a higher incidence of cardiovascular disease in men. However, little is known about the mechanism underlying the cardioprotective effects of androgens. Here we show the inhibitory effects of testosterone on vascular calcification and a critical role of androgen receptor (AR)-dependent transactivation of growth arrest-specific gene 6 (Gas6), a key regulator of inorganic phosphate (P(i))-induced calcification of vascular smooth muscle cells (VSMC). Testosterone and nonaromatizable androgen dihydrotestosterone inhibited P(i)-induced calcification of human aortic VSMC in a concentration-dependent manner. Androgen inhibited P(i)-induced VSMC apoptosis, an essential process for VSMC calcification. The effects on VSMC calcification were mediated by restoration of P(i)-induced down-regulation of Gas6 expression and a subsequent reduction of Akt phosphorylation. These effects of androgen were blocked by an AR antagonist, flutamide, but not by an estrogen receptor antagonist, ICI 182,780. We then explored the mechanistic role of the AR in Gas6 expression and found an abundant expression of AR predominantly in the nucleus of VSMC and two consensus ARE sequences in the Gas6 promoter region. Dihydrotestosterone stimulated Gas6 promoter activity, and this effect was abrogated by flutamide and by AR siRNA. Site-specific mutation revealed that the proximal ARE was essential for androgen-dependent transactivation of Gas6. Furthermore, chromatin immunoprecipitation assays demonstrated ligand-dependent binding of the AR to the proximal ARE of Gas6. These results indicate that AR signaling directly regulates Gas6 transcription, which leads to inhibition of vascular calcification, and provides a mechanistic insight into the cardioprotective action of androgens.

We report a 90-year-old man who was given a diagnosis of pleural effusion lymphoma (PEL) based on the detailed immunochemical and DNA analyses of the pleural effusion. He was bed-ridden and on enteral nutrition due to severe Alzheimers disease, and also had diabetes mellitus. He was transferred to our hospital with fever and massive pleural effusion. A cytological examination of the pleural effusion revealed class 5 atypical lymphocytes with a high nucleus/cytoplasm ratio. The origin of the atypical cells could not be determined by flow cytometry of the pleural effusion, which only suggested the existence of inflammatory changes. Considering his general physical status, further investigations were not performed. The respiratory failure progressed, and he died on the 45(th) hospital day. At autopsy, no atypical cells were identified in his organs other than in the right thoracic space. We conducted immunochemical staining after making a cell block from the effusion sample. Most of the atypical cells were CD30 positive, with human herpes virus-8 (HHV-8)-associated protein. A PCR analysis of the immunoglobulin heavy chain gene detected monoclonal rearrangement, thus indicating the atypical cells to be involved in the B-cell lineage. These findings led to a final diagnosis of PEL. PEL is a rare type of lymphoma confined to the body cavities without any prominent tumor mass, and its pathogenesis is related to HHV-8 infection. PEL develops mostly in immunocompromised patients, such as those with AIDS. However, it may also occur in elderly patients as well. We should therefore also consider the possibility of PEL in elderly patients presenting with pleural effusion of unknown origin.

Recent epidemiological studies have found that testosterone deficiency is associated with higher mortality largely due to cardiovascular (CV) disease in community-dwelling older men. We investigated whether a low plasma testosterone level could predict cardiovascular events in middle-aged Japanese men with coronary risk factors.

Arterial calcification makes the management of hemodynamics more difficult. Some reports have previously shown that simple assessment of aortic calcification using plain radiography is associated with cardiovascular (CV) events; however, these studies simply assessed whether aortic calcification was present or absent only, without considering its extent. Here, we evaluated validity of grading aortic arch calcification (AAC) to predict new CV events.

Arterial calcification is associated with cardiovascular (CV) disease, to be leading to vessel wall stiffness and causing the management of hemodynamics in the elderly more difficult. Here, we compared the extent of calcification in the aortic arch by reviewing chest X-rays to that in the abdominal aorta as assessed by more detailed examinations. In addition, the validity of the grading and the relationship of this useful grading to clinical risk factors were evaluated.

The aging process is unavoidably associated with a decline in functional physical capacity. To achieve the anti-aging, it is indispensable to tightly manage traditional risk factors and prevent several diseases, which lower the quality of life (QOL), including lifestyle-related diseases. Angiotensin II type 1 receptor blockers (ARB), anti-hypertensive agents, have various abilities beyond blood pressure lowering. Many basic researches and clinical trials have demonstrated the multiple functions of ARB (i.e., prevention of cardiac hypertrophy and new-onset of diabetes, renal protective and anti-oxidative capacities). In addition, recent researches show that new abilities of ARB as multi-organprotection (i.e., prevention of cognitive impairment and osteoporosis) are also worthy of remark. In the future, we are additionally anticipating the unlimited possibilities of ARB to aim for the successful aging.

The aim of this study was to compare the effects of paclitaxel, sirolimus, and everolimus on the senescent phenotype in human endothelial cells, and to further investigate possible involvement of mammalian sirtuin 1 (Sirt1) down-regulation as a mechanism.

Hyperphosphatemia has emerged as a cardiovascular risk factor that stimulates calcification in vessels. We explored molecules that were induced by inorganic phosphate (Pi) at an early stage in vascular smooth muscle cells (VSMC). In the present study, we examined the role of thrombomodulin (TM) in Pi-induced VSMC calcification based on the results of DNA microarray analysis. Both mRNA and protein expression of TM were markedly augmented in Pi-induced calcification. Conversely, knockdown of TM by siRNA significantly inhibited calcification, in addition to Pi-induced apoptosis which plays critical roles in VSMC calcification. We further found that TM suppressed both of mRNA and protein expression of growth arrest-specific gene 6 (Gas6), a key molecule regulating apoptosis. Recombinant extracellular epidermal growth factor (EGF)-repeat domain of TM exaggerated calcification and this effect was abrogated by a neutralizing antibody for EGF receptor, suggesting that the cleaved and secreted form of TM may activate EGF receptor. We also found that downregulation of Gas6 by TM/EGF receptor axis was mediated by ERK in VSMC calcification. In the aorta of adenine-fed rat, a typical medial calcification model with hyperphosphatemia, we found that TM expression was increased. Furthermore, in human calcified aorta, increased TM expression was also observed. These results indicate that TM is a novel molecule that promotes apoptosis and vascular calcification by regulation of Gas6, presumably via EGF receptor/ERK axis.

From May to October 2011, we conducted an 8-day homecare educational program for physicians, dentists, pharmacists, visiting nurses, long-term care managers, and hospital staff in Kashiwa city, Chiba, which was primarily intended to increase home visits by physicians. The characteristics of the program were as follows: 1) active and busy community physician participation, 2) attendance of practical training by physicians, 3) interprofessional discussion, 4) recruitment of participants from the same city, 5) recommendation of participant recruitment by a community-level professional association such as Kashiwa City Medical Association. By comparison of the pre- and post-program questionnaires completed by participants, the motivation for homecare practice, knowledge about homecare, and interactions with other professionals have increased. We will further standardize and generalize this program in order to contribute to homecare promotion in Japan.

Due to the rapidly increasing super-aging society, medical policy in Japan should be redefined. Therefore, the medical and nursing home care system should now be revised greatly. We need to change the current principle that is based on cure only. The patients should receive hospitable care closely connected with their life in their home-town(region)throughout their lifetime. This is termed as "home medical care system". Here, we promote patient-centered medical home care, which implements the chronic and/or End-Of-Life care models, in Kashiwa city, Chiba prefecture. This system is a promising framework for primary care transformation. There is a need for a multidisciplinary team-based care system using information and communication technology(ICT)with smooth and seamless cooperation. However, increased awareness among the workers engaged in home medical care is first required.

Hyperphosphatemia has clinically been associated with total mortality and cardiovascular mortality in patients with chronic renal failure (CRF). Recently, higher serum phosphate levels within the normal range have been shown to be associated with substantially increased risk of cardiovascular events even in patients without CRF. Therefore, it is clear that the phosphate axis may in fact play a role in atherogenesis. Accumulating mechanistic studies regarding local effects of phosphate on the vessel wall have recently provided insight into various pathways that culminate in vascular smooth muscle cell (SMC) calcification. SMC phenotypic change into osteochondrogenic differentiation and SMC apoptosis are essential roles in hyperphosphatemia-induced vascular calcification. In addition, Hyperphosphatemia induces endothelial dysfunction via various mechanisms, including a decline in nitric oxide release due to oxidative stress. The sodium-dependent phosphate cotransporter PiT-1 is required for these effects. This review shows the current knowledge about phosphate-induced changes in the vascular wall, leading to atherosis and sclerosis.

Although dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimers disease (AD), the clinical diagnosis is frequently difficult. Because both REM sleep behavior disorders and Parkinsons disease also have alpha-synucleinopathy similar to DLB, and show an increase in periodic limb movements (PLM), we evaluated the association between DLB and PLM, which may serve as an additional information to differentiate AD and DLB.

Considerable attention has been paid to the association between type 2 diabetes mellitus (T2DM) and cognitive dysfunction in the elderly. T2DM is often comorbid with several other metabolic disturbances, including hypertension and dyslipidemia. These comorbid diseases might be associated with cognitive impairment. Many clinical indices should be included as variables for the association with cognitive decline. In the current study, we tried to identify the associated factors with cognitive decline during a 6-year period in elderly T2DM considering the changes in the clinical indices during the follow-up period.

Recent evidence has shown that type 2 diabetes mellitus (T2DM) in the elderly is a risk factor for cognitive dysfunction or dementia. However, the precise mechanisms have not yet been elucidated. In the current study, we attempted to elucidate the association of clinical indices and diabetic complications at baseline with cognitive declines after 6-year follow up in type 2 diabetic elderly.

It is well known that a decline in physical activity is associated with lifestyle-related diseases including cardiovascular (CV) events. However, little is known about the association between physical activity and CV events in elderly patients, because recent accumulating reports have mainly dealt with middle-aged populations. In this study, we investigated the correlation between physical activity and CV events in Japanese elderly patients with type 2 diabetes mellitus (T2DM).

A decline in physical activity has been shown to be associated with metabolic syndrome (MetS), leading to cardiovascular events. However, this is difficult to manage well in the elderly with multiple atherosclerotic risk factors. In this study, we investigated the correlation between physical activity and clinical parameters in the presence and absence of MetS in Japanese elderly subjects with type 2 diabetes mellitus (T2DM). In addition, we determined which factor, calorie intake or physical activity, mainly contributes to the prevalence of MetS.

To evaluate the association of low-density lipoprotein, high-density lipoprotein and non-high-density lipoprotein cholesterol with the risk of stroke, diabetes-related vascular events and mortality in elderly diabetes patients.

Oxidative stress and atherosclerosis-related vascular disorders are risk factors for cognitive decline with aging. In a small clinical study in men, testosterone improved cognitive function; however, it is unknown how testosterone ameliorates the pathogenesis of cognitive decline with aging. Here, we investigated whether the cognitive decline in senescence-accelerated mouse prone 8 (SAMP8), which exhibits cognitive impairment and hypogonadism, could be reversed by testosterone, and the mechanism by which testosterone inhibits cognitive decline. We found that treatment with testosterone ameliorated cognitive function and inhibited senescence of hippocampal vascular endothelial cells of SAMP8. Notably, SAMP8 showed enhancement of oxidative stress in the hippocampus. We observed that an NAD(+)-dependent deacetylase, SIRT1, played an important role in the protective effect of testosterone against oxidative stress-induced endothelial senescence. Testosterone increased eNOS activity and subsequently induced SIRT1 expression. SIRT1 inhibited endothelial senescence via up-regulation of eNOS. Finally, we showed, using co-culture system, that senescent endothelial cells promoted neuronal senescence through humoral factors. Our results suggest a critical role of testosterone and SIRT1 in the prevention of vascular and neuronal aging.

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